| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,414 |
5,241 |
$289K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,631 |
767 |
$225K |
| D2740 |
Crown - porcelain/ceramic |
317 |
189 |
$219K |
| D0120 |
Periodic oral evaluation - established patient |
7,203 |
6,857 |
$174K |
| D1120 |
Prophylaxis - child |
2,888 |
2,848 |
$142K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,494 |
4,353 |
$127K |
| D0274 |
Bitewings - four radiographic images |
3,418 |
3,303 |
$125K |
| D0140 |
Limited oral evaluation - problem focused |
2,571 |
2,459 |
$100K |
| D0210 |
Intraoral - complete series of radiographic images |
1,245 |
1,212 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
816 |
434 |
$70K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
86 |
56 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
674 |
381 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,128 |
1,074 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
2,220 |
2,109 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
286 |
113 |
$21K |
| D0330 |
Panoramic radiographic image |
203 |
182 |
$16K |
| D0272 |
Bitewings - two radiographic images |
460 |
453 |
$14K |
| D1351 |
Sealant - per tooth |
261 |
54 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
98 |
73 |
$1K |